Objective Assessment Criteria Research Articles

Hidradenitis suppurativa: definition, epidemiology, etiology, diagnosis (part 1)

Hidradenitis suppurativa (HS) is a chronic recurrent skin disease characterized by development of autoimmune inflammation in the infundibulum of the hair follicle and apocrine sweat glands located in the axillary, inguinal, anogenital regions, submammary folds, near the areola of mammary glands and the umbilical region. HS is difficult to treat and has an extremely negative impact on the quality of life. HS is separated into a distinct clinical entity fundamentally different in etiopathogenesis from acute bacterial hidradenitis. The exact prevalence of HS is unknown, it varies greatly in different studies ranging from 0.03 to 4% in general population. The detection of IL-1β, IL-23, and IL-17 in the lesions indicates the key role of autoimmune inflammation involving Th17-lymphocytes in the pathogenesis of HS. Risk factors include smoking, obesity, mechanical friction, genetic predisposition. The diagnosis of HS relies on three obligatory criteria: characteristic distribution, typical morphology of the lesions and relapsing, chronic disease course. There is no “gold standard” in assessing the severity of the disease, since all available scoring systems have many limitations, therefore many questions regarding this disease remain unsolved at present — from terminology and clear and most objective assessment criteria for the severity of the process to the development of native clinical guidelines.

The Implementation of Authentic Assessment in Speaking Class based on MBKM Curriculum at the UMKABA University

The research investigates the implementation of authentic assessment in speaking learning within the independent curriculum framework at UMKABA. It highlights the appropriateness and coordination of applying authentic assessment, emphasizing its alignment with the cognitive, affective, and psychomotor domains of learning. The study underscores authentic assessment as a paradigm shift in learning evaluation, focusing on holistic skill and character development in line with the MBKM curriculum's goals. Key components of effective authentic assessment preparation, such as rubric creation and alignment with learning outcomes, are discussed. Challenges faced by lecturers in preparing clear and objective assessment criteria are acknowledged, yet the benefits of authentic assessment in fostering 21st-century skills are emphasized. The study concludes that authentic assessment under the Merdeka Curriculum offers a more comprehensive evaluation approach, encompassing not only knowledge but also skills and attitudes, thus providing students with diverse opportunities to showcase their abilities. Keywords: authentic assessment, speaking, MBKM Curriculum

Objective assessment criteria reduce the influence of judgmental bias on grading

Past research has indicated that students with a migration background are graded worse than those without a migration background, despite them showing the same level of academic performance. Negative implicit associations of teachers associated with these student characteristics could explain these findings. Objective assessment criteria, such as error tables, provide user-independent rules for the interpretation of results and could therefore help to ensure that the influence of student characteristics on assessment is reduced. To test this hypothesis, 157 pre-service teachers assessed a dictation. Two aspects were varied: the presentation of an error table for assessment and the name of the student who had written the dictation (with vs. without a supposed Turkish migration background). An implicit association test measured implicit associations of the pre-service teachers toward the performance of Turkish and German people. When no error table was used and the pre-service teachers had negative implicit associations toward the performance of people with a Turkish migration background, they graded students with a migration background worse than students without a migration background. No grading disparities were found when the error table was used. To reduce judgmental bias, the use of objective assessment criteria can therefore be recommended.

The influence of some general diseases for changes on the ocular surface after trabeculectomy

BACKGROUND: By now, possible effects of diabetes mellitus and arterial hypertension on the ocular surface changes after trabeculectomy have not been evaluated.
 AIM: Analysis of the effects of arterial hypertension therapy and diabetes mellitus on the ocular surface changes after trabeculectomy.
 MATERIALS AND METHODS: The study group consisted of 443 patients, including those with arterial hypertension (179 patients), non insulin dependent compensated type 2 diabetes mellitus (25 patients) and their combination (53 persons), operated in 2016–2020 in the City Multifield Hospital No. 2, Saint-Petersburg, for primary open-angle noncompensated glaucoma and then observed for 6 to 24 months. The dynamics of ocular surface disease index (OSDI), tear film break-up time (TBUT), and amount of total tear production has been studied.
 RESULTS: The probability of the trabeculectomy success did not depend on the concomitant comorbidity. In contrast to intraocular pressure, the criteria for subjective and objective assessment of the ocular surface state were not subject to such obvious changes. In diabetic patients, the studied criteria have not changed compared to the baseline.
 CONCLUSIONS: The mentioned systemic diseases do not influence the state of the ocular surface in patients with glaucoma, and are not an independent risk factor for the failure of the IOP-lowering surgical procedure. The presence of diabetes mellitus prevents the accompanying a successful trabeculectomy regression of symptoms and clinical and functional signs of dry eye disease.

Enhancing Teachers' Job Performance through Objective Performance Appraisal and Motivation: A Review

This review paper examines the nexus between performance appraisal, motivation, and teachers' job performance, synthesizing insights from eleven relevant articles. Effective performance management processes are pivotal in facilitating transparent communication of expectations and outcomes between employers and employees. The significance of teachers' motivation in driving productivity underscores the importance of establishing objective assessment criteria for evaluating their job performance. The complexity of work performance judgments necessitates a multifaceted approach to assessment aimed at enhancing the credibility of the evaluation process. Furthermore, feedback from both immediate supervisors and colleagues emerges as a valuable tool in fostering the professional development of teachers. This paper sheds light on the interplay between performance appraisal, motivation, and teachers' job performance, offering valuable insights for educators, administrators, and policymakers. Keywords: Performance, appraisal, motivation, teachers, job performance, assessment, feedback

Smart City Information Systems: Research on Information Published for Citizens and Design of Effective Content in the Czech Republic

The concept of Smart Cities integrates innovative technologies to improve citizens’ quality of life in towns and cities worldwide. Crisis management is a separate section directly managed by the leadership of municipalities, cities and counties in cooperation between police, fire and municipal police to ensure the safety of residents and safety in public spaces. The purpose of this study is to investigate to which extent publicly available information related to the field of crisis management is unavailable to residents in municipalities, towns and cities through online information systems. The primary aim is to provide suggestions for a general information system structure and content that would highlight and satisfy the need to address the crisis management issue, especially in providing immediate information to the population through an innovative online form. The achievement of this goal is methodologically based on qualitative research analysing and comparing the information published for residents through Smart City information systems in selected towns and municipalities. Document analysis or conceptual design was applied, and evaluation criteria for objective assessment of Smart City information systems were appropriately determined. The comparative analysis based on this set of criteria enabled the development of the proposals of information systems’ content that can be used to keep the information systems for Smart Cities in cities, municipalities and regions, actual and beneficial. From the available resources, two main modules that focused either on citizens or cities were synthesised. Moreover, SWOT analysis or the Smart Regions Rapid Response structure was derived. Acquired results outline generic structures and contents that support the development of the concept of Smart Cities and can be suitably implemented for the development of the modification of information systems containing relevant information for residents, cities and municipalities, focusing on citizen safety.

The Role of Goal Orientations and Communication Strategies in Willingness to Communicate in EMI Classrooms

Background: In English-medium instruction (EMI) classrooms, goal orientations, strategies, and communication play pivotal roles in facilitating effective learning. Achievement goal orientations (AGOs) guide and control learner competence-relevant behavior in academic performance. Communication strategies (CSs) are communication aids for learners to cope with problems or breakdowns while speaking the target language. Strategic competence is an indispensable affective-cognitive factor that promotes learners’ willingness to communicate (WTC) in a target language.
 Purpose: This study aims to investigate the role of AGOs and CSs in predicting WTC and the effect of English proficiency on AGOs and CSs in EMI classrooms.
 Methods: An online questionnaire survey regarding the perception of AGOs, CSs, and WTC was conducted with 595 university students taking one EMI course in social science and humanity domains in Taiwan. The items were on a 6-point Likert scale ranging from ‘strongly disagree’ to ‘strongly agree’. Hierarchical multiple regression was adopted to predict WTC in EMI classrooms. One-way between-group MANOVAs were adopted to examine the individual and joint effect of English proficiency on the AGOs and CSs.
 Results: The hierarchical multiple regression model showed that task goal orientations and social affective strategies strongly and positively predicted the university students’ WTC in the EMI classroom. Performance-avoidance goal orientations and message reduction and alteration strategies were found to negatively predict WTC in EMI settings. Students’ English proficiency neither predicted their WTC nor affected their AGOs in the EMI classroom. High-proficiency students adopted accuracy-oriented, fluency-oriented, and negotiation for meaning while speaking strategies more frequently than low-proficiency students.
 Conclusion: It is suggested that a supportive and dynamic classroom environment with higher-order learning tasks involving cooperation, reflection, and objective assessment criteria can be incorporated into EMI programs. Besides, instruction in CSs and the use of multimedia teaching aids can facilitate EFL learners’ comprehension of subject-specific materials and encourage them to engage more in EMI classrooms.

Most endovascular thrombectomy patients have Target Mismatch despite absence of formal CT perfusion selection criteria.

Endovascular thrombectomy (EVT) is the standard of care for large vessel occlusion stroke. Use of Computed Tomographic Perfusion (CTP) to select EVT candidates is variable. The frequency of treatment and outcome in patients with unfavourable CTP patterns is unknown. A retrospective analysis of CTP utilisation prior to EVT was conducted. All CTP data were analysed centrally and a Target Mismatch was defined as an infarct core ≤70 ml, penumbral volume ≥15ml, and a total hypoperfused volume:core volume ratio >1.8. The primary outcome was good functional outcome at 90 days, defined as a modified Rankin Scale (mRS) score 0-2. follow-up infarct volume, core expansion and penumbral salvage volumes were secondary outcomes. Of 572 anterior circulation EVT patients, CTP source image data required to generate objective maps were available in 170, and a Target Mismatch was present in 151 (89%). The rate of 90-day good functional outcome was similar between Target Mismatch (53%) and Large Core Non-Mismatch groups (46%, p = 0.629). Median follow-up infarct volume in the Large Core Non-Mismatch group (104ml [IQR 25ml-189ml]) was larger than that in the Target Mismatch patients (16ml [8ml-47ml], p<0.001). Despite a lack of formal CTP selection criteria, the majority of patients treated at our centres had a Target Mismatch. Patients without Target Mismatch had larger follow-up infarct volumes, but the functional recovery rate was similar to that in Target Mismatch patients. Infarct volumes should be included as objective assessment criteria in the evaluation of the efficacy of EVT in non-Target Mismatch patients.

Compact imaging system and deep learning based segmentation for objective longissimus muscle area in Korean beef carcass

With growing consumer interest in meat quality, the need for accurate quality assessment becomes increasingly important. One crucial factor of Korean beef quality is the longissimus muscle area, which is closely associated with both quality and yield grade. Currently, the measurement is visually assessed, introducing subjectivity and placing a substantial burden on inspectors in terms of labor. To address these challenges, we have developed a compact image acquisition system designed to acquire accurate grading assessment images of beef carcasses. Several preprocessing steps after image acquisition were conducted, including radial distortion correction and color calibration. We have employed conventional image-processing techniques and four deep-learning models to segment the longissimus muscle area using the calibrated images. Among the segmentation models, DeepLab model based on ResNet50 achieved the highest accuracy. It demonstrated a Global Accuracy, Weighted IoU, and Mean BF Score of approximately 99.26%, 98.54%, and 95.70%, respectively. The results of our study are expected to contribute to the development of objective criteria for loin area assessment. By enabling precise and consistent determination of beef carcass quality, our research has the potential to reduce labor requirements for inspectors and provide a standardized approach to assessing loin area.

A Novel Back-Propagation Neural Network for Intelligent Cyber-Physical Systems for Wireless Communications

Wireless sensor networks, which play a significant role in monitoring complex environments that change rapidly over time, were used in the Artificial Intelligence method. External factors or the device designers themselves are both responsible for this complex behavior. Sensor networks often use machine learning techniques to adapt to such conditions, eliminating the need for excessive redesign. Cyber-physical systems (CPS) appeared as the promising option for improving physical-virtual interactions. The quality of the system containing processing information is primarily determined by the system function. There are many benefits obtained while combining Artificial Intelligence (AI) and Cyber-Physical Systems (CPSs) in buildings. In CPS-based indoor environment has various design schemes containing measurement and intelligent buildings in the control system consisting of detection, tracking, execution, and communication modules. The Multi-Agent System (MAS) is the smallest control unit that simulates among neurons and it flexibly provides the information. To mimic the interactions between human neurons, multi-agents are used. In this paper, the CPS’s information world is built on the fundamental principle of granular formal concepts and the theory of granular computing is investigated. The calculation module is used by Back-Propagation Neural Network (BPNN) for pattern recognition and classification by environmental information. Various parameters namely the normalized root mean square error, peak signal-to-noise ratio, mean square error, and the mean absolute error are chosen as the objective assessment criteria to assess the benefits of the proposed method and the effectiveness of the proposed system is proven.

Usability of exergames as a home-based balance training tool for older adults: protocol for a systematic review

IntroductionExergames are used in the clinical practice of geriatric rehabilitation to increase physical activity levels and motivate players/patients. Their use in the home environment makes it possible to perform fun,...

Evidence-based approach to diagnosis and management of abdominal tuberculosis.

Abdominal tuberculosis is an ancient problem with modern nuances in diagnosis and management. The two major forms are tuberculous peritonitis and gastrointestinal tuberculosis (GITB), while the less frequent forms are esophageal, gastroduodenal, pancreatic, hepatic, gallbladder and biliary tuberculosis. The clinicians need to discriminate the disease from the close mimics: peritoneal carcinomatosis closely mimics peritoneal tuberculosis, while Crohn's disease closely mimics intestinal tuberculosis. Imaging modalities (ultrasound, computed tomography, magnetic resonance imaging and occasionally positron emission tomography) guide the line of evaluation. Research in diagnostics (imaging and endoscopy) has helped in the better acquisition of tissue for histological and microbiological tests. Although point-of-care polymerase chain reaction-based tests (e.g. Xpert Mtb/Rif) may provide a quick diagnosis, these have low sensitivity. In such situations, ancillary investigations such as ascitic adenosine deaminase and histological clues (granulomas, caseating necrosis, ulcers lined by histiocytes) may provide some specificity to the diagnosis. A diagnostic trial of antitubercular therapy (ATT) may be considered if all diagnostic armamentaria fail to clinch the diagnosis, especially in TB-endemic regions. Objective evaluation with clear endpoints of response is mandatory in such situations. Early mucosal response (healing of ulcers at twomonths) and resolution of ascites are objective criteria for early response assessment and should be sought at twomonths. Biomarkers, especially fecal calprotectin for intestinal tuberculosis, have also shown promise. For most forms of abdominal tuberculosis, sixmonths of ATT is sufficient. Sequelae of GITB may require endoscopic balloon dilatation for intestinal strictures or surgical intervention for recurrent intestinal obstruction, perforation or massive bleeding.

Patient-Specific Implants and Fat Grafting for Contour Deformities Post Craniosynostosis Reconstruction: A Therapeutic Approach.

Contour deformities after fronto-orbital advancement for craniosynostosis reconstruction are commonly encountered. There is a paucity of literature describing secondary procedures to correct such deformities with reported outcomes. An approach to defect analysis and procedure selection is lacking. The authors present our experience utilizing fat grafting (FG) and patient-specific implant (PSI) reconstruction as management strategies for this population. A retrospective analysis of consecutive patients who underwent secondary onlay PSI or FG for contour deformities after primary craniosynostosis reconstruction was carried out. Patient demographics, defect analysis, surgical approach, postoperative complications, and esthetic outcomes were recorded. Data were pooled across the entire cohort and presented in a descriptive manner. Fourteen patients (36% syndromic and 64% isolated) were identified that either underwent PSI (n = 7) with a mean follow-up of 56.3 weeks, FG (n = 5) with a mean follow-up of 36 weeks or a combination of both (n = 2) for deformities postcraniosynostis surgery. Supraorbital retrusion and bitemporal hollowing were the most common deformities. There were no intraoperative or postoperative complications. All patients achieved Whitaker class I esthetic outcomes and there were no additional revisions during the defined study period. The presence of a significant structural component or large (>5 mm) depression typically necessitated a PSI. Contour deformities after fronto-orbital advancement reconstruction can be successfully managed using FG and PSI either as a combination procedure or in isolation. The authors have proposed anatomical criteria based on our experience to help guide procedure selection. Future prospective studies would be beneficial in providing more objective assessment criteria.

Endoscopic intragastric injection of botulinum toxin in the treatment of patients with morbid obesity: opportunities and prospects

The authors consider modern epidemiological and demographic data on morbid obesity. Literature review is devoted to non-surgical treatment of patients with morbid obesity. The authors analyze the results of experimental and clinical studies on endoscopic intragastric injection of botulinum toxin and bariatric efficacy of this approach. The indications for endoscopic intragastric injection of botulinum toxin and advantages of this technique are clearly formulated. The authors identified the most significant criteria for objective assessment of clinical effectiveness of endoscopic intragastral injection of botulinum toxin, as well as scientific and methodological principles necessary for this technique. Clinical efficacy of intragastric injection of botulinum toxin including overweight loss, anorexigenic and gastroparetic effects indicates inconsistent results and certain unresolved problems. Thus, large-scale multiple-center randomized controlled trials and multivariate analysis are required to determine the role of endoscopic intragastric injection of botulinum toxin in complex treatment of patients with morbid obesity.

THE MANIFESTATION OF PSYCHOLOGISM IN THE PROSE OF ZH. NAZHIMEDENOV

The prose of Zh. Nazhimedenov is a new topic that has not been comprehensively analyzed and studied so far. In the article, Zh. Nazhimedenov's story "Betpe-bet (Face to Face)" is analyzed from a psychological point of view. Because psychology in fiction is a complex issue. Researches about psychology in works of art have been started in the long past. Since then, psychologism has acquired the character of a new landmark of public consciousness. The article is analyzed by separating three different meanings of social psychology. The main point of our analysis of the story " Betpe-bet" from a psychological point of view is that the language of the story, art, and the interaction between the reader and the character are skillfully presented. The writer combined the internal and external stress of the characters, in particular the mental evolution, with his own context. As a result, the soul world of the images in the work of art is deeply recognized. The research carried out in the article revealed various aspects related to the structure of the text in the story, features of the narrative. The creative personality of Zh. Nazhimedenov was analyzed from the point of view of separate literary pursuits. In addition, on the basis of analyzing the relationship between the author and the hero in the stories and the stylistic features of the narrative structure, the creative personality of Zh. Nazhimedenov was determined, and the original aspect of the psychologism here was recognized. The methods of psychologism in the story are based on describing the psychology of action, the intensity of the conflict, and the intensity of the story. And in such works, the psychological image plays a very important role in revealing the psychology of the creative personality. Therefore, in this case, it can be emphasized that Zh. Nazhimedenov found a psychological harmony with his character. Conclusions and reflections in the scientific article are based on the theory of literature and are based on objective assessment criteria. As a result, the story of the writer proves that it is rich in psychological aspects.

Factors Influencing Students’ Choice of and Success in STEM: A Bibliometric Analysis and Topic Modeling Approach

Contribution: This article lends empirical evidence to this research area of factors influencing students’ choice of and success in science, technology, engineering, and mathematics (STEM). Background: Understanding these factors is crucial as it informs recruitment and support interventions provided to students and constitutes a premise to improving graduation rates. The social cognitive career theory (SCCT) was used as a theoretical framework to provide insight regarding factors influencing students’ choice of qualifications. Research Questions: What is the state of research on the factors influencing students’ choice of and success in STEM programmes? Which of these factors have interested most researchers? What research themes are covered in articles investigating these factors? Methodology: This study followed the general bibliometric analysis workflow—study design, data collection, data analysis, data visualization, and interpretation. Data collection followed the preferred reporting items for systematic review and metaanalysis (PRISMA) guidelines. From an initial set of 408 articles, 179 related to the theme and were published in the Web of Science between 2004 and 2020. These articles were analyzed using the standard bibliometric metrics. Findings: Findings indicate that this research field is still growing. Thirty-two factors were identified and rated based using an objective assessment criterion. In addition, a classification of the factors is presented based on the SCCT. This study provides a theoretical reference for improving success rates for STEM qualifications and better understanding the theme. The study proposes a research agenda of what future research in the field should focus on, based on current gaps.

Assessing and reporting leaking of violent intent: Influences of perpetrator and witness characteristics

Because the police are reliant on laypersons to report announcements (leaking) of terrorist attacks, it is crucial to examine potential determinants for their assessment of the seriousness of leaking and the likelihood to report it. Members of the law enforcement authorities also need to decide which instances of leaking to prosecute further. We asked 392 laypersons and 188 police students to assess the seriousness and anticipated likelihood to report/prosecute leaking. Using a behavioral process tracing (BPT) task, we examined which further information they consider important for their decisions. We also assessed participant characteristics that may influence these decisions. Laypersons rated the seriousness of leaking higher than police students, but were less likely to report it to the police than police students were likely to have the leaking prosecuted. Both groups selected information about the potential perpetrator's criminal history, political attitude, and repetition of leaking most frequently. Accordingly, receiving information about the potential perpetrator's criminal past, right-wing attitude, and repetition of leaking in the BPT task was associated with increases in the seriousness ratings and the likelihood to report/prosecute leaking in both groups. Concerning the participants’ characteristics, particularly fear of terrorism (and partly political attitude and news consumption) predicted both the seriousness ratings and the likelihood to report/prosecute leaking. In conclusion, characteristics of both the potential perpetrator and the participants drove the decisions. Thus, it seems important to provide more information about the concept of leaking and to emphasize its importance in preventing terrorist attacks in order to improve the likelihood to report/prosecute it. Additionally, the development of objective assessment criteria for the police seems essential in order to reduce the influence of witnesses' characteristics on these decisions.

Assessment of the efficiency of implementation of public-private partnership projects taking into account their life cycles and key stakeholders’ interests

Objective: to develop criteria for objective and comprehensive assessment of the success of public-private partnership (PPP) projects.Methods: in the process of the research, the method of systematic literature review was used.Results: as a result of the study, it was concluded that the success of a PPP project is a relative concept and requires detailing (1) from the viewpoint of which particular stakeholder the project is evaluated and (2) relative to which stage of the project life cycle the assessment is made. This understanding allowed proposing a universal approach to assessing the success of PPP projects, based on the criteria assessment matrix developed by us, which takes into account the stages of the project life cycle and the interests of its stakeholders.Scientific novelty: the systematization of studies available in the Russian and world literature concerning the assessment of the success of both investment projects in general and PPP projects in particular allowed identifying a universal set of criteria for such an assessment. This, in turn, contributes to a more adequate and clear interpretation of the conclusions made by a wide range of authors of research in the field of PPP, who quite often refer to “successful” PPP projects, without giving their own understanding of the criteria for determining success.Practical significance: the developed criteria matrix for assessing the success of PPP projects can become a starting point for improving methodological approaches and normative-legal documents regulating the implementation of PPP projects at the federal and regional levels. Regional and municipal executive authorities planning the implementation of new PPP projects can use the proposed matrix for assessing the success of PPP projects in their work in order, on the one hand, to increase the investment attractiveness of the projects being developed, and on the other hand, to ensure better and objective control over their further implementation.

Timing of Anticoagulation after Acute Ischemic Stroke in Patients with Atrial Fibrillation.

Patients with atrial fibrillation (AF) and ischemic stroke are at high risk for stroke recurrence. Early anticoagulation may reduce the risk of recurrent events but is usually avoided due to the risk of hemorrhagic transformation (HT). Current guidelines are based on empiric expert opinion. The assumed risk of HT is based on historical data from an older generation of anticoagulants. The direct oral anticoagulants (DOACs) have demonstrated lower risk of intracranial hemorrhage compared to older anticoagulants. However, the optimal timing of DOAC initiation after AF-related ischemic stroke has remained an area of clinical equipoise, as the pivotal phase III trials did not include patients in the early period after ischemic stroke. Multiple prospective studies and a few smaller randomized controlled trials evaluating the safety and efficacy of early versus delayed DOAC initiation have been completed. These studies have reported promising results of early DOAC initiation after acute ischemic stroke. However, a standardized documentation of HT rates on follow-up imaging with objective assessment criteria is missing from most of these studies. Larger randomized trials of early versus delayed DOAC are ongoing. A literature review was performed using keywords and Medical Subject Headings in MEDLINE/PubMed and Google Scholar databases. For each relevant paper, the bibliography was scrutinized for other relevant articles and journals. In this article, we review the risk of recurrent ischemic stroke and HT in patients with AF, pathophysiology, classification, predictors, natural history, and outcomes of HT and discuss the studies of early anticoagulation after AF-related ischemic stroke.

Atypia in breast pathology: what pathologists need to know.

Despite the importance of atypia in diagnosing and classifying breast lesions, the definition of atypia varies depending on the context, with a lack of consistent and objective criteria for assessment. Atypia in breast pathology may be cytonuclear and/or architectural with different applications and implications. Cytonuclear atypia is used to assist the distinction of various intraductal epithelial proliferative lesions including usual ductal hyperplasia (UDH) versus atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS), and to grade DCIS. In invasive carcinoma, nuclear atypia (i.e., nuclear pleomorphism) is a component of the histological grading system. Stromal cell cytonuclear atypia is one of the key features used to distinguish fibroadenoma from phyllodes tumour (PT) and to classify PT as benign, borderline or malignant. Similarly, cytonuclear atypia is used in the evaluation of myoepithelial cell alterations in the breast. Architectural atypia is used to differentiate flat epithelial atypia (FEA) from ADH or DCIS. In addition to the inherent subjectivity in the interpretation of atypia, which presents as a morphological continuum reflecting a biological spectrum, the lack of standardisation in defining atypia augments diagnostic discordance in breast pathology, with potential implications for patient management. Evidence to date suggests that the traditional criteria used to assess atypia may require modification in the era of digital pathology primary diagnosis. This review aims to provide a comprehensive review of atypia in breast pathology with reference to inconsistencies, challenges and limitations.